Provider Demographics
NPI:1982627527
Name:SHAH, AITAZAZ A (MD)
Entity Type:Individual
Prefix:
First Name:AITAZAZ
Middle Name:A
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2900 N INTERSTATE 35
Mailing Address - Street 2:SUITE 118
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-5141
Mailing Address - Country:US
Mailing Address - Phone:940-380-8100
Mailing Address - Fax:940-380-8112
Practice Address - Street 1:2900 N INTERSTATE 35
Practice Address - Street 2:SUITE 118
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5141
Practice Address - Country:US
Practice Address - Phone:940-380-8100
Practice Address - Fax:940-380-8112
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL9471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175328701Medicaid
TX8S3490OtherBLUE CROSS OF TEXAS
TX8S3490OtherBLUE CROSS OF TEXAS
TXG11883Medicare UPIN